Medical Records Examiner

Commonwealth of Pennsylvania•Dauphin County, PA

1d•Hybrid

About The Position

This position lets you apply your nursing knowledge to ensure that care provided to recipients meets essential standards. You will help protect program quality by reviewing records and identifying concerns. Join this mission-driven agency and support fair, safe, and accurate medical assistance practices. This position centers on evaluating medical records, analyzing provider practices, and supporting case development to ensure compliance with Medical Assistance regulations. It involves conducting reviews, preparing documentation, and helping guide administrative actions.

Requirements

Three years of professional experience in the field of medical assistance, health care services, or human services; or An equivalent combination of experience and training.
Active authorization to practice as a Registered Nurse in Pennsylvania.
All employees possessing an active temporary practice permit must obtain licensure as a Registered Nurse within the one (1) year period defined by the Pennsylvania State Board of Nursing.
Possession of an active motor vehicle license.
Meet the PA residency requirement.
Able to perform essential job functions.

Responsibilities

Review medical records, claims history profiles, and related documents to identify discrepancies
Plan and direct case review activities while keeping the supervisor updated on progress
Conduct on-site visits, interviews, and peer review meetings to assess service quality and detect potential fraud
Prepare written reports summarizing reasons for review, findings, violations, and recommendations
Participate in evidentiary meetings and discuss case history, findings, and strategies with agency staff
Appear as a witness in hearings or trials to provide information related to case development and evidence handling